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Covid Booster / Flu Vaccination Booking Request
Step
1
of
2
– Screening Questions
0%
Unique ID
Do you work for Hull University Teaching Hospitals NHS Trust?
(Required)
Yes
No
This form is only for staff who work at Hull University Teaching Hospitals NHS Trust, and their households. Please book using the
NHS national vaccine booking system
.
Personal Information
Name
(Required)
Forename
Surname
Email Address
(Required)
Enter Email
Confirm Email
Date of Birth
(Required)
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Mobile Number
(Required)
HEY/NHS number (if known)
Employee Number
Also known as your employee ID, ESR number or payroll number
Are you frontline?
(Required)
Yes
No
Are you clinically vulnerable?
(Required)
Yes
No
Do you have any allergies?
(Required)
Yes
No
What are the allergies?
(Required)
Health Group
(Required)
Clinical Support Services
Corporate Directorates
Emergency Medicine
Estates, Facilities and Development
Family and Women's Health
Medicine
Surgery
Department
(Required)
6th Floor Coordinators
AAA Screening
Academic Medicine (CHH)
Academic Oncology
Acute Medicine Med Staff
Acute Providers Collaborative
Acute Surgery Medical Staff
Admin Bank
Admissions/Legal
Alcohol Care Team
Ambulatory Care/Day Services
AMU Nursing HRI
AMU/Emergency Dept Admin Staff
Anaesthetic Medical Staff
Anaesthetic Practitioners
Anaesthetics – Cardio
Anaesthetics – ICU
Anaesthetics – Obstetrics
Anaesthetics – Pain
Anaesthetics A&C Staff
ARAS Airways Team
Archiving
Aseptic Unit
Assistant Director of Nursing
Audiology Department HRI
Bank Nurses Ex RHH
Blood Sciences Medical Staff
Bowel Screening
Brain & CNS Therapy Team
Breast Clinics CHH
Breast Screening Unit
Breast Surgery – Specialist Nurses
Breast Surgery Medical Staff
Breast Symptomatic Services
Brocklehurst/Bilton NHS Clinics
Cancer and Diagnostic Services Management
Cancer Assessment Unit
Cancer Psychological Service
CAPD Renal
Capital & Planning
Capital Schemes
Car Parking and Security
Cardiac 5 Day Ward
Cardiac Cath Lab – CHH
Cardiac Surgery Medical Staff
Cardiology Med Staff/Specialty
Cardiology Specialist Nurses
Cardiothoracic Audit Dept CHH
Care Records Service
Catering Services CHH
Catering Services HRI
Cath Lab
CellPath Medical Staff
Central Decontamination Unit
Centre for Metabolic Bone Disease
Chemical Pathology
Chest Med Med Staff/Specialty
Chest Med Outpatients HRI
Chest Medicine Specialist Nurses
Chief Executive
Clin Haem Med Staff/Specialty
Clinical Audit & Effectiveness
Clinical Coding
Clinical Engineering
Clinical Engineering Community
Clinical Immunology
Clinical Oncology Med Staff
Clinical Skills Building
CMU / Ward 28 Cardiology CHH
Colorectal Medical Staff
Colorectal Surgery – Specialist Nurses
Comms and Web Services
Community Midwifery
Community Paediatrics
Compliance
Continuous Quality Improvement
CORP Clinical Nurse Educators
Corporate Affairs
Costing and Income
COVID19 Central
Covid19 Testing Team
Critical Care Clinical Nurse Educators
Critical Care Outreach Service
CT Department – HRI
CT Surgery Theatres CHH
CT-Comm Diagnostic Centres
Cystic Fibrosis Service
Day Case Surgery Unit CHH
Day Case Surgery Unit HRI
Day Surgery 3 CHH
Day Unit CHCC
Derm Med Staff/Specialty
Dermatology – Specialist Nurses
Dermatology Unit
Dietetics
Digital Exemplar (LDE)
District Records
DME Med Staff
DME Nurse Management
DME Outreach Wbourn
Domestic Services All Sites
ED Clinical Educators
ED Data Quality
Education and Development
Elderly Assessment Unit
Elective & UEC Improvement
Electrical Clinical Observation System
Electrocardiography Card CHH
Emergency Dep Med Staff HRI
Emergency Dept Nurse Practitioners
Emergency Dept Nursing Staff HRI
Emergency Dept Paediatrics
Employee Service Centre
Endo Med Staff
Endo/Diabetes Admin Staff
Endoscopy Unit CHH
Energy and Utilities CHH
Enhanced Care Team
ENT – Specialist Nurses
ENT Medical Staff
ENT Outpatients CHH
ENT/Breast Theatres CHH
EPAU
EPDM System
ERMEC Deanery Funded
ERMEC Non Rechargeable
ERMEC Resus Training HRI
E-Rostering
Estates Department CHH
Estates Department HRI
Finance Admin
Foundation Community Posts
Fracture Clinic HRI
FT Strategy – Finance
Gastro Admin & Clerical Staff
Gastro Med Staff/Specialty
Gastro Theatre HRI
Gastroenterology – Specialist Nurses
General Office
GP Scheme Employer
Grounds and Gdns (CHH)
GS1 System Implementation
Gynae Oncology Med Staff/Specialty
Gynae Theatres HRI
Gynaecology Oncology
Gynaecology Spec Nurses
H&ER Public Mortuary HRI
H30 Cedar Ward
H31 Maple & H33 Rowan Wards
H34 Acorn Ward
Haemophilia Specialty
Head of Corporate Human Resources
Heads of Finance
Health & Safety
Heart Failure Service
HEE – CPD
HEPATITIS C INITIATIVES
HEY Improvement Team
HIV Service
Home Ventilation
Hospital At Night
HR Advisory Service
Hub 10 – Clinical Admin
Hub 11 – Clinical Admin
Hub 1a – Clinical Admin
Hub 1b – Clinical Admin
Hub 2 – Clinical Admin
Hub 3 – Clinical Admin
Hub 4 – Clinical Admin
Hub 5 – Clinical Admin
Hub 6 – Clinical Admin
Hub 7 – Clinical Admin
Hub 8 – Clinical Admin
Hub 9 – Clinical Admin
HUTH Provider
HYMS Medical School
I&D Management
IBD Specialist Nurses
ICNARC HRI
ICU A+C Staff
ICU CHH
ICU HRI
ID Admin Staff
ID Specialist Nurses
Immunology/Haemophilia OPD
Inf Diseases Med Staff/Specialty
Infection Control
Information Services
Integrated Care System (ICS)
Integrated Discharge Team
Interventional Rad Theatre HRI
IT Services Department
Laund and Linen Serv (All)
Libraries Management
Liver Specialist Nurses
Lung Health Admin
Lung Health Check
LWAB
Management Emergency Care
Maternal Mental Health
Max Fax Lab HRI
Max Fax Specialist Nurses
Maxillo Facial Outpatients
MDT Coordinators
MED HG Covid-19
Medical Bank
Medical Day Services
Medical Director
Medical Equipment Library
Medical Examiner
Medical Illustration
Medical Library HRI
Medical Oncology Med Staff
Medical Outpatients HRI
Medical Physics STP and PTP
Medical Records Management
Medicine Service Management
MHG Admin Team CHH
MHG Admin Team HRI
Microbiology Medical Staff
Midwifery Education
Midwifery Led Unit
Molecular Imaging Research Centre
MRI Department – HRI
MRI-Comm Diagnostic Centres
MTPEP Programme Office
Neonatal Med Staff/Specialty
Neonatal Specialist Nurses
Neurology Med Staff/Specialty
Neurology Spec Nurses HRI
Neurophysiology Dept HRI
Neurosurgery – Specialist Nurses
Neurosurgery A&C Staff
Neurosurgery Medical Staff
Newborn Hearing Screening
NHS Bank Staff
NHSX IBD
NMABS
Nuclear Medicine Department
Nuclear Medicine Physicists
Nurse Endoscopists
Nursing Apprentices
Nursing Chaplains
Nursing Services
Nutrition CNS Team
Obs/Gynae Med Staff/Specialty
Obstetric Spec Nurses
Occupational Health HRI
Occupational Therapy
ODN (Critical Care Network)
Oncology Med Staff/Specialty
Oncology Specialist Nurses
Ophthalmology – Specialist Nurses
Ophthalmology Medical Staff
Ophthalmology Outpatients
Ophthalmology Pre – Assessment
Ophthalmology R&D Fund
Ophthalmology Unit Theatres
Ophthalmology Ward / Daycase Unit
Optometry Department
Oral Surgery Consortium
Oral Surgery Medical Staff
Oral Surgery Theatres CHH
Organisational Development
Orthopaedic Medical Staff
Orthopaedic Patient Admin & Audit
Orthopaedic Surgery – Specialist Nurses
Orthopaedic Theatres CHH
Orthoptics Ophthal Department HRI
Outpatient Antibiotic Service
Outpatient Clinics CHH
Outpatient Clinics ERCH
Paed Surg Med Staff/Specialty
Paediatric Med Staff/Specialty
Paediatric Nurse Management
Pain Service – Chronic
Palliative Med Specialist Nurses
Palliative Med Staff/Specialty
Parental Education
Patient Experience
Patient Meal Services
Patient Safety & Improvement
PAU
Performance Management
Perfusion Dept CHH
PHDU
Phlebotomy Dept HRI
Physiology CHH
Physiotherapy
Plastic Surgery – Specialist Nurses
Plastic Surgery Medical Staff
Plastic Trauma Clinics
Portering Services CHH
Portering Services Post Room
Pre Admission Service
Progress to Discharge Unit (PDU)
Property Services
Prosthetic Service Syke St
Providers – Scunthorpe Vac Site
Psychology Services
Pulmonary Function Unit CHH
Purchase Accounts
R&D Academic Cardiology
R&D Academic Oncology Trial Fund
R&D Colorectal Surgery
R&D Commercial Studies
R&D Dermatology
R&D Diabetes Fund
R&D Dr Patel Rheumatology
R&D Gastro IBD Nurse Fund
R&D Infectious Diseases
R&D Interventional Cardiology
R&D Renal Research Fund
R&D Respiratory General
R&D Trauma & Orthopaedics Medical A/C
R&D UKCLRN Funding Gastro/Hepto
R&D UKCLRN Funding Paediatrics
R&D UKCLRN Office CHH
R&D Vascular Surgery Research
Radiation Physics Department
Radiation Protection
Radiol Gen and Screen CHH
Radiol Gen and Screen HRI
Radiology Administration CHH
Radiology General – ERCH
Radiology IT
Radiology Management
Radiology Medical Staff
Radiology Nursing – CHH
Radiology Nursing – HRI
Radiotherapy
Radiotherapy Physics
Rapid Diagnostics Programme
Records Libraries CHH
Recovery Service Theatres CHH
Recovery Service Theatres HRI
Regional Training Centre Endoscopy (CHH)
Rehabilitation
Rehabilitation Engineering
Renal Admin Staff
Renal Med Staff
Renal Specialist Nurses
Reporting Radiographer
Research & Development
Research & Development – Anaesthetics
Retinal Screening
Rheum Med Staff
Rheumatology Specialist Nurses
Risk Team
Robot Theatre Staffing
Safeguarding Children HRI
SAME DAY EMERGENCY CARE (SDEC)
SHYPS
Site Management
Specialist Nurses – Clinical Haematology
Specialist Nurses – Endo/Diabetes
Specialist Services Management
Speech Therapy
Statutory Compliance
Stoma Care – Specialist Nurses
Strategy and Planning
Stroke Services
Stroke Specialist Nurses
Supplies Department
Surgery 1 Management
Surgical Admissions Lounge
Switchboard
System Bank Staff
System Programme Management Office
Team 1 – Neurosurgery
Team 2 – Vascular
Team 3 – Orthopaedics
Team 4 – Max Fax
Tech Development Group
Teenage and Young Adult Unit
Telecommunications
The Department of Pharmacy
Theatres Education Department
Theatres General (CHH)
Theatres General HRI
Thoracic Surgery Medical Staff
Tobacco Advisory Team
Transformation and Change Team
Transfusion Services
Transport Services Non Patient
Trauma Centre
Ultrasound
Ultrasound – HRI
Upper GI – Specialist Nurses
Upper GI Admin & Clerical Staff
Upper GI Medical Staff
Upper GI Theatres
Urology Medical Staff
Urology Surgery – Specialist Nurses
Urology Theatres CHH
Vaccination Programme
Vascular Lab HRI
Vascular Surgery – Specialist Nurses
Vascular Surgery Admin & Clerical Staff
Vascular Surgery Medical Staff
Virtual Respiratory Ward
Ward 1 HRI
Ward 10 – Colorectal Surgery CHH
Ward 10 Endo HRI
Ward 100 (Gastro/Gm HRI)
Ward 11 Colo Rectal Surgery CHH
Ward 11 Stroke Serv HRI
Ward 110 Stroke Unit HRI
Ward 12 HRI
Ward 120 HRI
Ward 14 Upper GI Surgery CHH
Ward 15 Urology CHH
Ward 16 (Breast – CHH)
Ward 20 (NCTR)
Ward 26 CT Surgery CHH
Ward 27 CT Surgery CHH
Ward 29 Rehab CHH
Ward 30 CHH
Ward 31 CHH
Ward 32 CHH
Ward 33 CHH
WARD 38 HRI
Ward 4 Neuro HRI
Ward 40 Neuro HOB
Ward 5 Chest Med HRI
Ward 50 Renal HRI
Ward 500 Chest Medicine HRI
Ward 6 Acute Admissions HRI
Ward 60 Acute Admissions HRI
Ward 7 CHH
Ward 7 Vascular Surgery HRI
Ward 70 Rheumatology HRI
Ward 8 Eld Med
Ward 9 Elderly Medical
Ward 9 Ortho/Breast CHH
Ward 90 Eld Med HRI
Ward Catering Service
Ward H130 Paediatrics
Ward H39
Waste Management
WCH Gynaecology OP (HRI)
Wch Labour and Delivery (HRI)
Winter Ward-H1
WISHH
Womens and Childrens ANC/ADU HRI
Womens and Childrens NICU HRI
Womens and Childrens Paediatric OP HRI
Womens/Childrens Serv Mgt
Workforce Planning
Role
(Required)
Booking Request
Which vaccination would you like to book?
(Required)
Both
Covid Booster
Flu
Would you be happy to receive both vaccinations on the same day or would you prefer them on separate days?
(Required)
Same day
Separate days
Site Preference
(Required)
Please choose which sites are convenient for you to receive your vaccination.
HRI
CHH
1st preferred appointment date
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MM
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YYYY
2025
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2019
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2015
2014
2013
2012
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2009
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1935
1934
1933
1932
1931
1930
1929
1928
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1926
1925
1924
1923
1922
1921
1920
1st preferred appointment time
08.00-10.00
10.00-12.00
12.00-14.00
14.00-16.00
Please note clinics are available Monday to Friday 08.00-16.00
2nd preferred appointment date
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YYYY
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
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1994
1993
1992
1991
1990
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1952
1951
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1949
1948
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1945
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1941
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1939
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1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
2nd preferred appointment time
08.00-10.00
10.00-12.00
12.00-14.00
14.00-16.00
Please note clinics are available Monday to Friday 08.00-16.00
Name
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